[CAPE TOWN] Despite South Africa’s peaceful transition from apartheid to democracy two decades ago, the country remains burdened with infectious and non-communicable diseases, says a new report.p> Bongani Mayosi and Solomon Benatar, health researchers from South Africa-based Groote Schuur Hospital and University of Cape Town, examined the trends in health and wealth from articles identified in PubMed — an online database — from 1994 to 2014.

The New England Journal of Medicine published the report last month (2 October), saying that although South Africa has reversed past unfair practices through social transformation, the country’s large population of poor people still suffer from health issues.

Major health challenges include large disparities in wealth, the increase in associated diseases of poverty, and widening differences in healthcare.

“South Africa accounts for the worst global tuberculosis epidemics fuelled by the spread of HIV infection.The incidence of tuberculosis increased from 300 per 100,000 people in the early 1990s … to more than 950 per 100,000 in 2012.”

Authors of new report

The authors say health problems emanated from extreme poverty through lack of the basic requirements for life such as clean water, adequate nutrition, reasonable housing conditions, access to vaccinations and good schooling.

“More than 10 million people live on less than US$1 per day,” says the report. “Even at an income of US$4 per day, the quality of life would not be remotely near the level that the majority of South Africans had hoped for after the end of apartheid.”

Mayosi tells SciDev.Net that economic growth has created an increasing population of black middle class, giving them greater access to the advanced medical care offered in the private sector.

Mayosi adds that the profile of students admitted to medical schools and of those graduating and entering practice is now reflective of gender and race, but the enrolments and graduations are insufficient to meet national need.

“South Africa accounts for the worst global tuberculosis epidemics fuelled by the spread of HIV infection,” the report notes. “The incidence of tuberculosis increased from 300 per 100,000 people in the early 1990s … to more than 950 per 100,000 in 2012.”

The prospect of non-communicable diseases burden increase is higher, the report notes, explaining that as antiretroviral treatment cuts mortality from HIV/AIDS, more people are living longer, adding pressure on healthcare services.

Mayosi suggests a need to tackle poverty because of its impact on health.

Ronelle Burger, associate professor in the department of economics at Stellenbosch University, South Africa, says the proposed health reform under the country’s national health insurance scheme is set to address some of these challenges.

“But given that we have only seen a vision and a wish list and very little in the way of a feasible plan, it is not clear whether these reforms will be able to bring about change,” she tells SciDev.Net.

Burger adds: “Better cost control, tougher negotiation and more centralised purchasing can help to reduce the cost of [health] provisions, but I think the difficult fight is not affordability, but quality of care”.